Provider Demographics
NPI:1043566219
Name:MEKAMKWE, PATRICIA NGOZI
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NGOZI
Last Name:MEKAMKWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5517
Mailing Address - Country:US
Mailing Address - Phone:191-753-3960
Mailing Address - Fax:
Practice Address - Street 1:2738 FENTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5517
Practice Address - Country:US
Practice Address - Phone:191-753-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502258041174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator